Mediterranean Journal of Rheumatology最新文献

{"title":"An Observational Case-Control Study of the Anti-Inflammatory Effects of Bromelain on Peripheral Blood Mononuclear Cells from Patients with Systemic Lupus Erythematosus.","authors":"Abhijit Pati, Bidyut K Das, Sarit S Pattanaik, Aditya K Panda","doi":"10.31138/mjr.111125.air","DOIUrl":"10.31138/mjr.111125.air","url":null,"abstract":"<p><strong>Background: </strong>Bromelain is a proteolytic enzyme that has been investigated as an adjuvant for treating autoimmune disorders. However, data regarding the role of bromelain in systemic lupus erythematosus is limited. In the present study, we examined the effect of bromelain on the mononuclear cells of SLE patients, precisely its anti-inflammatory properties.</p><p><strong>Materials and methods: </strong>Peripheral blood mononuclear cells (PBMCs) from SLE patients and healthy controls were stimulated with bromelain (10μg/ml), lipopolysaccharide (10μg/ml), or without any stimulant and cultured for 12 hours. The supernatants were harvested and quantified for IL-1β, TNF-α, IL-6, and IL-17A levels. The mean cytokine levels were compared among different groups using ANOVA and Tukey's post hoc test.</p><p><strong>Results: </strong>Our study revealed that PBMCs of SLE patients (n=41) had significantly higher levels of IL-6 (P=0.0003) and IL-1β (P<0.0001) compared to healthy controls (n=36). When stimulated with lipopolysaccharide, PBMCs of SLE patients showed even higher cytokine levels than healthy controls (IL-6:P<0.0001, TNF-α:P=0.01; IL-1β:P<0.0001). However, the most significant finding was that PBMCs stimulated with bromelain exhibited reduced levels of IL-1β (P<0.0001) and TNF-α (P<0.0001) compared to unstimulated cells of SLE patients. Moreover, cells subjected to lipopolysaccharide and bromelain stimulation displayed lower levels of all cytokines than those stimulated with lipopolysaccharide alone (IL-6:P=0.005, TNF-α:P<0.0001, IL-1β:P<0.0001, IL-17A:P=0.02).</p><p><strong>Conclusions: </strong>The present study highlights the anti-inflammatory role of bromelain in SLE patients by reducing the production of pro-inflammatory cytokine levels in vitro cultured PBMCs derived from SLE patients. Bromelain may be an efficacious adjuvant in managing inflammation in SLE; however, further studies are required.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 2","pages":"370-376"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retinal Vaso-Occlusive Complications Associated with Systemic Lupus Erythematosus: A Systematic Review of Clinical Presentation and Visual Outcomes.","authors":"Zunaira Amjad, Fatima Ameer, Hareem Farooq, Hassan Farooq, Habibah Sheikh, Moeez Saqib, Muhammad Zain Ameer, Huzefa Habib, Muhammad Husnain Riaz, Amna Khalid, Aleenah Mohsin, Aqeeb Ur Rehman","doi":"10.31138/mjr.120125.cas","DOIUrl":"10.31138/mjr.120125.cas","url":null,"abstract":"<p><strong>Background: </strong>Ophthalmic involvement in systemic lupus erythematosus (SLE), particularly retinal vascular diseases, remains under-recognised despite its potential to cause severe visual impairment. This systematic review aims to evaluate the clinical presentation, pathophysiology, and treatment outcomes of retinal vascular diseases associated with SLE.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted across PubMed/MEDLINE, ScienceDirect, Cochrane and Google Scholar using a combination of relevant MeSH terms. Data were extracted independently and quality assessment was conducted using the Joanna Briggs Institute Critical Appraisal Tool.</p><p><strong>Results: </strong>A total of 35 studies, corresponding to 39 patients, were included in quantitative synthesis. Mean age of patients was 27.8±12.9 years. Most patients were from India (n=10; 25%) and the USA (n=8; 20%), with a majority being female (n=31; 79.5%). Unilateral visual disturbances were reported in 25 (64%) cases while 14 (36%) patients showed bilateral symptoms. Disease was sudden in onset in 23 (59%) and followed a progressive course in 16 (41%) patients. Common findings included Central Retinal Artery Occlusion (CRAO) n 24 patients (61.5%) and Central Retinal Vein Occlusion (CRVO) in 22 patients (56.4%). 36 patients (92%) were treated with steroids but only 25% responded positively, necessitating the use of immunosuppressants in 24 (61.5%) and anticoagulants in 16 (41%) patients. Among the 38 patients where outcomes were reported, only 2 (5%) achieved complete recovery, 14 (37%) showed partial recovery, and 20 (52.6%) showed no improvement.</p><p><strong>Conclusion: </strong>Retinal vascular involvement in SLE is rare but associated with significant visual morbidity. Early diagnosis and combined immunosuppressive therapy may improve outcomes. Further research is required to stan-dardise treatment protocols.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 2","pages":"277-287"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Older Age, Steroid Exposure, and Digital Pitting Scars Predict Poor Outcomes in Scleroderma Renal Crisis: A 30-Year Retrospective Cohort Study.","authors":"Abhishek Gollarahalli Patel, Sakir Ahmed, Narayan Prasad, Vikas Agarwal","doi":"10.31138/mjr.140725.epr","DOIUrl":"10.31138/mjr.140725.epr","url":null,"abstract":"<p><strong>Background: </strong>Scleroderma renal crisis (SRC) is a rare but severe complication of systemic sclerosis (SSc), often associated with high morbidity and mortality. Data from Indian population remains limited.</p><p><strong>Objectives: </strong>To describe the clinical features, predictors, and outcomes of SRC in a large, single-centre Indian SSc cohort over three decades.</p><p><strong>Methods: </strong>This retrospective cohort study included 880 SSc patients diagnosed between 1990 and 2019, classified by ARA 1980 or ACR/EULAR 2013 criteria. SRC was defined by new-onset hypertension and/or rapidly progressive renal failure, with supportive hematologic and urinary findings. Demographic, clinical, and serologic variables were analysed. Predictors of SRC were identified using multivariate logistic regression, and survival was assessed using Kaplan-Meier and Cox regression analyses.</p><p><strong>Results: </strong>SRC occurred in 27 patients (3.0%), with 85.2% developing SRC within one year of diagnosis. Steroid use preceded SRC in 66.6% of cases. SRC was associated with older age (OR 1.03, 95% CI 1.001-1.072), digital pitting scars (OR 6.16, 95% CI 1.60-23.65), and reduced by immunosuppressive therapy (OR 0.39, 95% CI 0.16-0.98). SRC patients had a significantly higher mortality risk (HR 3.66, 95% CI 1.94-6.89) and shorter survival (mean 7.2 vs. 23.8 years). Dialysis was required in 51.8% of SRC cases.</p><p><strong>Conclusions: </strong>SRC affected 3% of SSc patients and was associated with high mortality and dialysis dependence. Older age, steroid exposure, and digital pitting scars were key risk factors, while immunosuppression appeared protective. These findings highlight the importance of early identification and careful therapeutic strategies in high-risk patients.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 2","pages":"383-390"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Familial Mediterranean Fever and the Gut Microbiota: A Dual Perspective Review of Current Evidence.","authors":"Isabelle Basbouss-Serhal, Fatima Fayad","doi":"10.31138/mjr.010725.flj","DOIUrl":"10.31138/mjr.010725.flj","url":null,"abstract":"<p><p>Familial Mediterranean Fever is a well-known autoinflammatory disease resulting from mutations in the MEFV gene. A recent development has linked FMF pathogenesis and mode of expression to the gut micro-biota. There may be a change in the gut microbiota profile of FMF patients, characterised by low diversity and a depletion of beneficial bacteria. Dysbiosis tends to be linked to increased gut permeability, systemic inflammation, and low response to colchicine treatment. Probiotics and prebiotics, in this case, may help restore the previous idyllic state of the microbial balance, along with a reduction in inflammatory markers, thereby demonstrating therapeutic merit. Notably, however, it did argue in some instances that changes in the microbiota were secondary to the genetic and inflammatory nature of FMF itself. It is still important to carry out longitudinal studies of naïve patients that will integrate metagenomics with immune profiling to ascertain whether microbial changes arise from causes, contributions, or coincidence in the pathogenesis of FMF.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 2","pages":"302-308"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regression and Disappearance of Accelerated Nodulosis with Adalimumab.","authors":"Georgios A Drosos, Anastasia K Zikou, Paraskevi V Voulgari, Alexandros A Drosos","doi":"10.31138/mjr.031125.ara","DOIUrl":"10.31138/mjr.031125.ara","url":null,"abstract":"","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 2","pages":"437-439"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical Activity or Exercise: Is there any Difference in Common Symptoms and Quality of Life Among Female Patients with Rheumatic and Musculoskeletal Diseases? A Qualitative Study.","authors":"Dimitra K Bonia, Anastasia Beneka, Asimenia Gioftsidou, Paraskevi Malliou","doi":"10.31138/mjr.161125.rad","DOIUrl":"10.31138/mjr.161125.rad","url":null,"abstract":"<p><strong>Aim: </strong>The purpose of this study was to explore female patients' experiences regarding systematic exercise compared with low-intensity physical activity in relation to common symptoms and quality of life in RMDs.</p><p><strong>Methods: </strong>A qualitative study was conducted using semi-structured, face to face interviews. Fifteen women with RMDs were recruited; thirteen completed the interviews and were included in the analysis. Interviews lasted approximately 30 minutes and were audio-recorded. Data were analysed using Thematic Analysis following the six-phase approach of Braun and Clarke. Participants were categorised based on self-reported engagement in either systematic exercise or low-intensity physical activity (e.g. walking). NVIVO 15 software was used for data management and analysis.</p><p><strong>Results: </strong>Participants' mean age was 58.3 ±13.38 years. Five a priori thematic areas were explored (pain, fatigue, depression, quality of life and exercise/physical activity), while an additional theme regarding barriers to participation emerged inductively. Most participants reported limited awareness of the distinction between physical activity and exercise. Women engaged in systematic exercise described more favourable experiences regarding symptoms management and quality of life, whereas those performing low-intensity physical activity primarily emphasised psychological benefits. Barriers to participation included physical limitations, fatigue, and motivational factors.</p><p><strong>Conclusion: </strong>From patients' perspectives, systematic exercise and low-intensity physical activity are perceived differently in relation to symptom experiences and quality of life. These differences highlight the importance of individualised, patient-centred exercise counselling for women with RMDs.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 2","pages":"391-398"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in Rheumatology: A Comprehensive Bibliometric Analysis and Current Scientific Mapping Research.","authors":"Maria Polyzou, Johanna Mucke, Anna Kernder, David Kiefer, Xenofon Baraliakos, Philipp Sewerin","doi":"10.31138/mjr.211025.err","DOIUrl":"10.31138/mjr.211025.err","url":null,"abstract":"<p><p>The bibliometric analysis presented in this article delves into the use of Artificial Intelligence (AI) in Rheumatology, aiming to fill a gap in the existing relevant scientific literature. In the article a holistic comprehensive overview of key trends and research clusters in the field are provided, exploiting a number of widely recognised bibliometric techniques, such as citation analysis, co-authorship analysis, co-occurrence analysis, and bibliographic coupling analysis. Notably, the citation analysis reveals a diverse array of highly cited papers, underscoring the multidimensional nature of research in rheumatology. The co-authorship analysis illuminates complex collaborative networks among countries, with prominent clusters such as the European, USA and the Asian-Pacific clusters, highlighting the dynamic and interconnected nature of international collaborations. The co-occurrence analysis identifies four thematic clusters, emphasising the interconnectedness of rheumatic diseases, prediction methods, artificial intelligence algorithms considerations and patient characteristics. Addressing limitations, including the potential bias introduced by specific keywords and database restrictions, in conclusion, the article provides valuable insights for researchers, paving the way for further refinements in understanding the evolving use of AI in rheumatology.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 2","pages":"288-301"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iguratimod in Autoimmune Diseases: Emerging Evidence for its Immunomodulatory and Therapeutic Role.","authors":"Clara Joseph Shilpa, Nikita Chettri, Hema Sameera Pinnam, Sruthy Jose, Mahabaleshwar Mamadapur","doi":"10.31138/mjr.060925.iar","DOIUrl":"10.31138/mjr.060925.iar","url":null,"abstract":"<p><strong>Background: </strong>Rheumatoid arthritis (RA) is a chronic autoimmune disorder marked by joint inflammation and damage, leading to disability. Traditional treatments include methotrexate and other DMARDs, but many patients experience inadequate responses or intolerable side effects. Iguratimod (IGU), a novel synthetic DMARD developed in Japan, has shown promise in the management of RA and related autoimmune conditions.</p><p><strong>Methodology: </strong>A comprehensive literature review was conducted using databases such as PubMed, Google Scholar, ScienceDirect, Web of Science, and Medline, focusing on recent high-quality publications related to iguratimod and employing keywords like \"Iguratimod,\" \"Sjögren's syndrome,\" \"Sjögren's disease\", \"Rheumatoid arthritis,\" and \"Ankylosing spondylitis\".</p><p><strong>Results and discussion: </strong>Clinical trials have demonstrated that iguratimod effectively reduces disease activity in RA patients, showing a comparable efficacy to salazosulphapyridine and improved outcomes when combined with methotrexate. In patients with Sjögren's disease, IGU significantly decreased disease activity indices and immunoglobulin levels. Furthermore, studies indicate that IGU has a favourable safety profile with fewer adverse effects than traditional DMARDs. The findings suggest that IGU offers a viable alternative for patients with RA and other autoimmune diseases who are intolerant to conventional therapies. Its dual action as an immunomodulator and anti-inflammatory agent positions it as a beneficial option for managing these chronic conditions.</p><p><strong>Conclusion: </strong>Iguratimod is a promising therapeutic option for the treatment of rheumatoid arthritis, Sjögren's disease, and ankylosing spondylitis. Further research is warranted to establish long-term efficacy and safety profiles and explore its potential in combination therapies for patients with inadequate responses to existing treatments.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 3","pages":"498-505"},"PeriodicalIF":2.1,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, Attitudes, and Clinical Experience with Cannabinoid Therapies: A Cross-Sectional Survey of Rheumatologists.","authors":"Ahmed Mougui, Zineb Baba, Imane El Bouchti","doi":"10.31138/mjr.310825.hct","DOIUrl":"10.31138/mjr.310825.hct","url":null,"abstract":"<p><strong>Aim: </strong>In Morocco, cannabinoid therapies have recently been legalised. This study aimed to explore the knowledge, attitudes, and perceptions of Moroccan rheumatologists toward these emerging treatments.</p><p><strong>Methods: </strong>A pretested online questionnaire was distributed via email to all members of the Moroccan Society of Rheumatology. The survey assessed participants' knowledge, prescribing confidence, perceived risks, safety precautions, and barriers to the use of cannabinoid therapies.</p><p><strong>Results: </strong>Of the 400 rheumatologists contacted, 126 responded (response rate: 32%). Among them, 59.5% reported confidence in their knowledge of cannabinoid therapies. A total of 80.6% of respondents believed that pharmacological cannabinoids may have a role in managing rheumatic diseases, while 9.7% declared that there is currently no therapeutic role for cannabinoids in rheumatology. Only 7.1% had recommended a therapeutic trial, and 52.8% expressed concern that the use of cannabinoids may cause patients to discontinue effective standard treatments. Fibromyalgia was the most frequently cited indication (85.7%). The main barriers to prescribing cannabinoid therapies were concerns about a history or risk of substance abuse (79.2%) and patient non-compliance with medical advice (79.2%).</p><p><strong>Conclusion: </strong>This finding highlights hesitation and caution toward these emerging treatments in Morocco. There is a clear need for evidence-based guidance to support rheumatologists in clinical decision-making concerning cannabinoids.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 2","pages":"377-382"},"PeriodicalIF":2.1,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impaired Bone Physiology in Rheumatoid Arthritis: Can the Wnt Pathway be the Connecting Link Between the Synovium and the Bone?","authors":"Michail I Krikelis, Dimitra Moschou, Konstantina Zoupidou, Evangelia Mole, Konstantinos Makris, Simeon Tournis, Sousana Gazi, Vassilios Nikolaou, Clio Mavragani, Efstathios Chronopoulos","doi":"10.31138/mjr.140925.eri","DOIUrl":"10.31138/mjr.140925.eri","url":null,"abstract":"<p><strong>Introduction and methods: </strong>Rheumatoid arthritis (RA) is a chronic inflammatory disease characterised by bone loss. A Medline/PubMed search was conducted in September 2025 using the keywords \"rheumatoid arthritis\" AND \"bone loss.\" The search was restricted to recently published review or systematic review articles (2020-2025). In total, 24 articles were thoroughly reviewed.</p><p><strong>Results: </strong>Inflammation-induced accelerated bone resorption both at the systemic level and in juxta-articular bone is typical to rheumatoid arthritis. Bone formation and bone biomechanics are also impaired due to inflammation, prolonged or repeated corticosteroid treatment, and muscle wasting.</p><p><strong>Conclusions: </strong>Aberrant bone loss and impaired bone formation are hallmarks of rheumatoid arthritis. The underlying pathophysiological mechanisms differ between early and refractory disease, suggesting a potential central role of the highly conserved Wnt pathway in the bone impairment observed in established RA.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 3","pages":"464-468"},"PeriodicalIF":2.1,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}